Citation NR: 9632180
Decision Date: 11/14/96 Archive Date: 11/22/96
DOCKET NO. 95-17 015 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Detroit,
Michigan
THE ISSUES
1. Entitlement to service connection for a left knee
disorder.
2. Entitlement to service connection for left wrist
disorder, to include post-traumatic arthritis of the left
wrist.
REPRESENTATION
Appellant represented by: Military Order of the Purple
Heart
ATTORNEY FOR THE BOARD
Saundra L. Crane, Associate Counsel
INTRODUCTION
The veteran served on active duty from November 1987 to
November 1990.
This matter comes before the Board of Veteran Appeals (“Board
or BVA”) on appeal from an April 1994 rating decision by the
Department of Veteran’s Affairs (VA) Regional Office (RO) in
Detroit, Michigan. In that decision, the RO denied the
veteran’s claims seeking entitlement to service connection
for left knee and wrist disorders. By that same rating
action, the RO also denied entitlement to a permanent and
total rating for nonservice-connected disability pension
purposes. In filing his substantive appeal, the veteran
specifically limited his appeal to the issues of entitlement
to service connection for a left knee and wrist disorders.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran essentially contends the RO erred in not granting
the benefits claimed on appeal. The veteran maintains, in
substance, that the conditions he is seeking to have
established as service-connected disabilities had their onset
during his period of military service. The veteran
specifically refers to treatment he received for left knee
pain and a left wrist injury during his period of active
military service. The veteran relates that his knee pain is
due to running and physical training, and that his chronic
wrist pain is the result of an injury he suffered while in
service. Reference is made to the evidence of record as
supporting these contentions. Therefore, a favorable
determination with respect to both issues has been requested.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1995), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that, with resolving all reasonable
doubt in the veteran’s favor, the record supports a grant of
service connection for patellar tendinitis of the left knee;
but that the veteran has not met the initial burden of
submitting evidence sufficient to justify a belief by a fair
and impartial individual that his claim for service
connection for a left wrist disorder, to include traumatic
arthritis, is well grounded.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran’s appeal has been obtained by the
RO.
2. There is a reasonable possibility that patellar
tendinitis of the left knee developed during service.
3. A left wrist disorder, to include post-traumatic
arthritis of the left wrist, was not present during service
and there is no continuity of symptomatology of a left wrist
disorder after service.
4. Post traumatic arthritis of the left wrist was not
manifest to a compensable degree within one year after
service and has not been linked to injury during service.
CONCLUSIONS OF LAW
1. Resolving all reasonable doubt in favor of the veteran,
patellar tendinitis of the left knee was incurred during
service. 38 U.S.C.A. §§ 1110, 1131, 5107(a) (West 1991); 38
C.F.R. §§ 3.102, 3.303 (1995).
2. The claim for post-traumatic arthritis of the left wrist
is not well grounded. 38 U.S.C.A. §§ 1110, 1112, 1113, 1131,
5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309
(1995).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
In general, service connection may be established for a
disability resulting from a personal injury or disease
contracted in line of duty, or for aggravation of a
preexisting injury or disease. 38 U.S.C.A. § 1110 (West
1991); 38 C.F.R. §§ 3.303, 3.306 (1995). If arthritis is
manifest to a degree of 10 percent within one year after
separation from service, the disorder may be presumed to have
been incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113;
38 C.F.R. §§ 3.307, 3.309 (1995). In addition, if a
condition noted during service is not shown to be chronic,
then generally a showing of continuity of symptomatology
after service is required for service connection. 38 C.F.R.
§ 3.303(b) (1995).
I. Entitlement to Service Connection for Left Knee Disorder
The Board recognizes that the veteran has presented a claim
that is well-grounded or plausible within the meaning of 38
U.S.C.A. § 5107(a) (West 1991). The Board is also satisfied
that the duty to assist mandated by 38 U.S.C.A. § 5107(a)
(West 1991) has been fulfilled and there is no indication of
available evidence which would be relevant to the claim for
the left knee.
The service medical records show that the veteran complained
on numerous occasions of pain in his left knee while on
active duty, particularly after long marches or physical
training while in service. Specifically, the record reflects
that in 1988 the veteran was treated for possible strain of
his left and right knees. Diagnoses of retro-patellar pain
syndrome and patellar tendinitis of the left knee were
entered as early as June 1989, following recurrent complaints
of knee pain during service. The veteran’s separation
examination is not of record.
Upon VA examination in November 1992, approximately two years
after service discharge, the diagnoses included chronic pain
of the left knee, although the clinical findings revealed no
fracture or abnormality. No assessment was rendered as to
the cause of the veteran’s left knee pain. Objective
findings from a 1995 VA medical examination disclosed
tenderness over the left patellar tendon with diagnoses of
patellar tendinitis of the left knee and probable
patellofemoral dysfunction.
In this case, the Board observes that the repeated diagnoses
of patellar tendinitis in service, and the post-service
diagnosis of the same by a VA examiner in 1995 raise a
reasonable doubt as to whether the veteran developed a
chronic left knee disability in service. Accordingly,
resolving that doubt in the veteran’s favor, the Board
concludes that patellar tendinitis of the left knee is of
service onset and may be service connected.
II. Entitlement to Service Connection for Left Wrist
Disorder
As previously discussed, the initial inquiry in reviewing any
claim before the Board is whether the veteran has presented
evidence of a well-grounded claim; that is, one that is
plausible or capable of substantiation. The veteran carries
the burden of submitting evidence "sufficient to justify a
belief by a fair and impartial individual that the claim is
well-grounded." 38 U.S.C.A. § 5107(a); Murphy v. Derwinski,
1 Vet.App. 78, 81 (1990). If he has not presented a well-
grounded claim, his appeal must fail. See Grivois v. Brown,
6 Vet.App. 136, 140 (1994); Boeck v. Brown, 6 Vet.App. 14, 17
(1993).
In order for a claim for service connection to be well
grounded, there must be “competent evidence of current
disability (a medical diagnosis); of incurrence or
aggravation of a disease or injury in service (lay or medical
evidence); and of a nexus or link between the in-service
injury or disease and the current disability (medical
evidence).” See Caluza v. Brown, 7 Vet.App. 498, 506 (1995)
(citations omitted). The nexus requirement may be satisfied
by a presumption that certain diseases manifesting themselves
within certain prescribed periods are related to service.
See Traut v. Brown, 6 Vet.App. 495, 497 (1994); Goodsell v.
Brown, 5 Vet.App. 36, 43 (1993).
The veteran has stated that his left wrist causes him mild,
but constant pain. The service medical records show that the
veteran was treated for a left wrist injury in June 1989.
The veteran reported that it was swollen and he was informed
that it was broken. However, while the treatment record
states edema was present, no diagnosis of a fractured wrist
was recorded or is found anywhere in the available service
medical records.
The service medical records after June 1989 are negative for
any complaints of pain, treatment, or diagnosis of the left
wrist disability, although the Board is aware that the
separation examination is not of record. The veteran was
discharged in 1990; in 1991 he filed a claim for compensation
for a left knee disorder [see discussion I] without reference
to wrist pain or the presence of a wrist disability.
Although a VA examination conducted in 1992 resulted in a
diagnosis of chronic wrist pain, x-rays taken contemporaneous
with that examination showed no evidence of a fracture,
dislocation, or bony or soft tissue abnormality of the or
right wrist. A diagnosis of arthritis was not reported.
The objective findings of the 1995 VA examination show a
normal range of motion of the left wrist. The results from
the clinical tests, including the x-ray studies of the left
wrist, were within normal limits. The diagnosis included
post-traumatic arthritis. However, there is no medical
evidence of record which casually relates this disorder to
the veteran’s in-service injury.
The Board observes that while service medical records show an
injury to the left wrist, there is no medical evidence of a
nexus or link between that injury and the veteran’s current
condition which would satisfy the well-grounded requirement.
Additionally, the evidence of record does not demonstrate
continuity of symptomatology and may not be reasonably
construed to find that the veteran had continuing symptoms
during service which could be causally related to his current
arthritis of the left wrist. 38 C.F.R. § 3.303(b); see also
Morton v. Principi, 3 Vet.App. 508, 509 (1992) [medical
evidence of veteran’s current condition is not material to
the issue of service connection].
Moreover, although arthritis is a chronic disease subject to
presumptive service connection under 38 C.F.R. § 3.309, for
arthritis to be service-connected by presumption, VA
regulations require manifestation within one year of
separation from service. There is no evidence in the record
that the current post-traumatic arthritis of the left wrist
was manifested within the presumptive period. 38 C.F.R.
§§ 3.307, 3.309 (1995).
The Board finds that there is no medical evidence as to the
causation of the veteran’s post-traumatic arthritis in his
left wrist, and, a lack of continuity of symptomatology from
the time of the in-service wrist injury to the diagnosis of
arthritis. Accordingly, the claim of entitlement to service
connection for a left wrist condition, currently identified
as post-traumatic arthritis, must be denied. Appropriate
evidence of a link to service would enable the veteran to
well ground the claim.
In determining that the veteran’s claim is not well grounded,
the veteran’s claim is being decided on a different legal
basis than used by the RO, specifically a denial because the
claim is not well grounded rather than because the
preponderance of the evidence is against the claim. The
veteran has not been prejudiced by the Board’s decision. The
RO simply accorded him a broader standard of review that the
evidence warranted. See Bernard v. Brown, 4 Vet.App. 384,
394 (1993). In any event, the quality of evidence the
veteran would need to well ground his claim or to reopen it
on the basis of new and material evidence is nearly the same.
Edenfield v. Brown, 8 Vet.App. 384, 390 (1995) (en banc).
ORDER
Service connection for a left knee disorder, identified as
patellar tendinitis, is granted.
Service connection for a left wrist disorder, to include post
traumatic arthritis of the left wrist, is denied.
CHARLES E. HOGEBOOM
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1995), a decision of the Board of Veterans'
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans' Judicial Review Act,
Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The
date which appears on the face of this decision constitutes
the date of mailing and the copy of this decision which you
have received is your notice of the action taken on your
appeal by the Board of Veterans' Appeals.
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